NPIMap

Organization Active NPI

Marion Regional Healthcare System

Doing business as Carolina Pediatrics

  • Pediatrics Physician
  • Mullins, SC
National Provider Identifier
1720092570
Registry record updated Nov 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MARION REGIONAL HEALTHCARE SYSTEM
Doing business as
Carolina Pediatrics
Practice address
2845 E Highway 76
Suite 5a
Mullins, SC 29574-6037
Phone
(843) 431-2710
Fax
(843) 431-2716
NPI assigned
Jul 28, 2006
Last updated
Nov 8, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Harold E Tucker
Title
Chief Executive Officer
Phone
(843) 431-2405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

2845 E Highway 76
Suite 5a
Mullins, SC 29574-6037

Mailing address

PO Box 1150
Marion, SC 29571-1150
Phone (843) 431-2710

Other identifiers 2

IdentifierTypeStateIssuer
GP4562MedicaidSC
288183MedicaidSC

Other names 1

  • Carolina Pediatrics Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194480000000",
    "number": "1720092570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1150",
            "city": "MARION",
            "state": "SC",
            "postal_code": "295711150",
            "telephone_number": "843-431-2710",
            "fax_number": "843-431-2716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 E HIGHWAY 76",
            "address_2": "SUITE 5A",
            "city": "MULLINS",
            "state": "SC",
            "postal_code": "295746037",
            "telephone_number": "843-431-2710",
            "fax_number": "843-431-2716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARION REGIONAL HEALTHCARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-11-08",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "843-431-2405"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4562",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288183",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mullins, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.